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To enhance the quality of organized mammographic screening in Italy, in accordance with national legislation, a multidisciplinary panel of experts applied the Grading of Recommendations, Assessment, Development and Evaluation (GRADE)-ADOLOPMENT approach to adopt or adapt the European Commission Initiative on Breast Cancer (ECIBC) guidelines concerning the use of digital breast tomosynthesis (DBT). As prerequisite conditions for DBT adoption, the panel defines a full extension to women in the 45-74 age range, sufficient technical and professional resources, and an adequate monitoring system. The panel recommends the use of either DBT or digital mammography (DM) for asymptomatic women participating in organized screening programmes. However, it suggests prioritizing DBT in women with high mammographic breast density(classified as BI-RADS class c or d) when density has been previously assessed with DM. In the case of limited resources, priority in the implementation should be given to women with extremely dense breasts (BI-RADS class d). The use of DBT as an additional screening tool alongside DM is not recommended. These guidelines aim to provide a tailored approach for screening women with high mammographic breast density, improving detection while optimizing resource allocation in the context of organized screening. However, these recommendations also apply to the setting of spontaneous screening.